Bedsores on an elderly incontinent patient in a Dublin nursing home were found to have been contaminated by faecal matter, the High Court heard yesterday.
A South Western Area Health Board inspector told Ms Justice Finlay Geoghegan the dressing and partly exposed wound was covered by faeces.
Ms Marie Faughey, the board's director of public health nursing, said the wound edges were raw and ragged indicating sheering of the skin consistent with the inadequacy of the size and type of dressing used.
Ms Regina Buckley, the board's assistant chief executive, told the court the welfare of 23 residents, 11 of whom were dependent on assistance, at Rostrevor Nursing Home, Orwell Road, Rathgar, Dublin, required the board to act immediately.
Ms Faughey and Ms Buckley were giving evidence in an application by the board for a High Court order directing the home's closure and dispersal of residents to suitable accommodation.
Ms Faughey found the standard of wound care and pressure area dressing below acceptable standards at the home owned by Ms Teresa Lipsett. Hygiene and cleaning were also unsatisfactory. She told the court she found morphine ampules, subject to the Misuse of Drugs Act, lying in open-topped pill boxes on medicine trolleys and cupboards.
Drug authorisations for six patients were undated and the register to record a daily check on all controlled drugs had no entry for the morphine ampules.
"The resident for whom they had been prescribed was no longer resident in the home," she told the court. Ms Faughey said she found a gauze dressing on a patient not secured by tape which did not cover the area of the pressure sore. The patient was incontinent and faeces also covered the surface of the dressing and the area of the wound which was exposed.
Ms Buckley said Rostrevor Nursing Home had failed to comply with conditions of registration as a nursing home. Staffing regulations, staff training and drug administration had been breached. The home had failed to keep a record of drugs and medicines administered.
Ms Mary Phelan, counsel for the health board, also outlined to the court inspectors reports which noted fire regulation breaches at the home and the non existence of fire drills and evidence of residents smoking in their bedrooms. The reports stated that front and rear entrances to the home had been found unsecured and patients had been known to wander out.
Ms Phelan said prosecutions had been brought before the District Court to be heard on September 28th but even if the District Court held in favour of the board there was no guarantee the home would be closed down. The board wanted a High Court direction closing the home and ordering the dispersal of the patients elsewhere.
Ms Phelan said the board could not provide and train the necessary staff to take over the running of the home.
Mr Gavin Ralston, SC, for the nursing home and its owner, Ms Lipsett, said he would challenge the jurisdiction of the High Court to make any orders on the closure of the home and would make his legal submissions today. Ms Lipsett, who was not in court, said in an affidavit that each resident was attended by his or her own GP. She had had severe difficulty recruiting staff.
She said she took issue with most of the facts presented in the grounding affidavits. The allegations were mostly historical and matters had moved on. Recommendations of the board's inspectors had been implemented.
Ms Lipsett said she intended to make full representation to the board regarding the continuation of the home's certificate of registration.
Since the board had made its initial application to close the home she had spoken to all residents and their families and without exception they had informed her they wished to remain in the home.
Ms Phelan said relatives of the residents may not be aware of the extent of the breaches of regulations. The date of the death of a female patient was found not to have been recorded by the home.
Mr Ralston will make legal submissions today on behalf of the home after which Ms Justice Finlay Geoghegan is expected to rule on the question of jurisdiction.